We have reported that a variety of stressful stimuli cause marked increases in noradrenaline (NA) release in the extended brain regions in the rats by measuring levels of both regional NA and its major metabolite, 3-methoxy-4-hydroxyphenylethyleneglycol sulfate (MHPG-S04) and by utilizing intracerebral microdialysis technique. Usually, the period of stress exposure employed in these studies was more than 30 min. However, a very short duration of stress such as immobilization stress only for 1 min could increase NA release in such brain regions as the hypothalamus, Iocus coeruleus (LC) region, hippocampus, cerebral cortex and midbrain 20 or 40 min after cessation of stress to the extent of those caused by continuous stress for 45 min. Although diazepam, a typical anxiolytic of benzodiazepines, significantly attenuated increases in NA release caused by stress in such brain regions as the hypothalamus, amygdala and LC region, etc., these effects of diazepam were observed only when the drug was administered immediately before, but neither 10 min before nor 10 min after stress exposure. Met-Enkephalin, an opioid peptide, injected i.c.v., also attenuated stress-induced increases in NA release in the brain regions, however, these attenuating effects appeared when the peptide was administered only immediately before, but neither 5 min nor 10 min after stress exposure. Met-Enkephalin, injected only immediately before stress exposure, significantly attenuated emotional responses such as defecation and weight loss shown by stressed rats. These findings suggest that there might exist the triggering mechanism, which once the animal was exposed to stress, even if such a short period as 1 min, begins to cause serial stress responses, which resulted in increases in NA release in the extended brain regions induced by 1 min immobilization stress followed by 20 or 40 min rest. The finding that alpha-helical CRF, an antagonist of corticotropin releasing factor (CRF) , administered immediately before stress exposure, significantly attenuated stress-induced increases in brain NA release, suggests that CRF could be involved, in part, in this triggering system. The recent findings on psychoneuroimmunomodulation suggest the involvement of immune system in this alarm mechanism.

View full abstract

In the history of psychosomatic medicine in Japan, so called hypnotic psychotherapy had been used widely for the treatment of patients with psychosomatic disease with considerable efficacy. Recently, however, heterohypnotic psychotherapy has been seldom used in clinical medicine in Japan. One of the reasons that this therapy has been discontinued, is the introduction of the theory of alexithymia to Japan. According to this theory, hypnotizability of patients with psychosomatic disease is low and, therefore, hypnotic psychotherapy is considered to be ineffective. Another reason is the extremely low payment for this therapy by Japanese health insurance. More recently, autogenic therapy, developed on the basis of autohypnosis, has been used for the treatment of patients with psychosomatic disease. Heterohypnotic psychotherapy seems to have a considerable effect on some patients. It is high time that we should reconsider the use of heterohypnotic psychotherapy for the treatment of patients with psychosomatic disease.

View full abstract

Through my experience and reflection as a physician in charge of psychosomatic internal medicine, internal medicine, and gastroenterology, I will present the current situation of psychosomatic medicine and proposal for the 2lst century focusing on (1)differences among internal medicine, psychosomatic medicine in internal medicine, and independent psychosomatic medicine, (2)roles of general psysicians and specialized psysicians in the field of psychosomatic medicine, (3) novel relationship between functional disorders and emotional disorders, (4)therapeutic self, (5)roles of psychosomatic medicine in primary care, and (6)establishment of Oriental remedies for life-style related diseases. Especially, creation of remedies for life-style related diseases unique to Japan based on Oriental points of view in addition to conventional behavioral medicine is urgently required for physicians specializing in psychosomatic medicine. It is necessary to grasp diseases as abnormality of the system including natural environment and to change out sense of value from that focusing on humans to that considering humans as only one factor of the numerous life systems.

View full abstract

There are many important factors to consider in psychosomatic obstetrics and gynecology, such as sexual health, sexual life, female's psychological condition, hormone and the autonomic nervous system, many syndromes and many symptoms, family relationships, quality of life, ethical and social factors, emergency care, terminal stage care, abortion and stillbirth, and care during and after delivery, etc. In our obstetrical and gynecological duties, we routinely assist in deliveries and perform surgery. In Sapporo Medical College, for a 19 year period from 1975 to 1993 Ioaded schedules have necessarily limited the number of outpatients we were able to treat to a mere 2 or 3% of the total number of new patients. However, since we opened Hoyukai Sapporo Clinic, 3 years ago, 10% of our new outpatients have been treated as psychosomatics. In comparison with other psychosomatic gynecological diagnoses in our new clinic, climacteric syndrome the percentage of patients is extremely high. I compared the Japanese society of psychosomatic obstetrics and gynecology with its international counterpart. There are far fewer member in the Japanese society (under 150) than in the international one (over 1,500) . In Japan the members consist almost exclusively of doctors and nurses, but in foreign countries the members come from varied professions, including psychotherapists, case workers and anthropologists. Recently, "mother-baby units" and "key centers of psychosomatic women's health" have been started in European countries. We opened "The Key Center for Psychosomatic Women's Health in Japan" in our clinic 3 years ago. Since then we have talked every month to people in general about various women's diseases and bio-psychosocio-ethical problems, and also discussed various problems of the doctor-patient relationship during these talks. I feel that recently public awareness concerning informed consent and psychosomatic medicine has gradually increased in Japan.

View full abstract

Some of the mechanisms of psychosomatic diseases in children, for example, nocturnal enuresis and tic disorders were found already. N ow, this provides us with a possibility to use some drugs for these disorders and we also can recognize their natural courses. We need to differenciate the improvement due to effective psychosomatic treatment from natural courses. In our experience, there were some patients with psychosomatic-like symptoms whose diagnoses were difficult to make in the early stage. It is important to make correct diagnoses as soon as possible in the early stage of treatment. Now, The Committee for Education of the Japanese Society of Psychosomatic Pediatrics has begun to correct and evaluate these cases for further education. Also, there are not enough chances for paediatricians to learn psychosomatic medicine in children. We are preparing ourselves a new suitable system for the education, which includes not only lectures and seminars, but also a short-term training program at special out-patient clinics.

View full abstract

The skin serves as an essential anatomic and physiologic shield between the body and its environment. Emotional factors usually contribute an important element in dermatoses. No experienced dermatologist will deny that psychological factors often appear to play some part in the initiation, aggravation or perpetuation of a wide variety of skin disorders. But, many dermatologists are not familiar with present state of psychological knowledge of skin diseases. I investigated the actual condition of medical education for psychosomatic medicine in the field of dermatology, and how dermatologists tackle psychosomatic diseases. It seems necessary for dermatologists themselves to study psychosomatic medicine positively.

View full abstract

In the dental field, there are various symptoms, problems or conditions that need to be dealt with by psychosomatic measures. These include glossalgia, temporomandibular dysfunction syndrome, chronic pain, polysurgery, oral dysodia (subjective halitosis) , dental fearful patients, faintihg 'fit, psychological problems and problems related to dental treatment in children, Iiaison consultation between psychodiagnosis medicine and psychiatry, dental treatment of insane patients such as schizophrenics who are likely to make unusual complaints or show problem behaviors, unfit dentures, and education of occlusion to treat patients with arthrosis of the TMJ as well as to improve the health of the whole person. It has been proposed that in the twenty-first century, dentists should be educated so as to properly deal with psychosomatic probiems in the hope that unhealthiness in mind and body due to unsatisfactory chewing, which is one of the bad habits caused by a modern lifestyle, can be improved by dental treatment.

View full abstract

In considering psychosomatic medicine for the 21st century from the standpoint of psychiatrists, a report on the present status of psychosomatic medicine together with a proposal is presented with focus on general hospital psychiatry and psychosomatic medicine. It cannot be denied that the approach taken by psychiatrists to date in psychosomatic medicine has been inadequate in Japan. The large contributory factor involved is the fact that in Japan the practice of psychosomatic medicine has primarily belonged to mental hospitals. With this as background, the Japanese Society of General Hospital Psychiatry was established in 1988 and as one of its main activities, efforts have been made by psychiatrists to substantiate and develop psychosomatic medicine. In the survey conducted after the establishment of the Society, it was found that the outpatient clinic of general hospital psychiatry responsible for psychosomatic medicine had made a steady development. We have also made efforts toward the substantiation of psychosomatic medicine through the introduction of biofecdback medical care in general hospital psychiatry. This experience of ours and the results of questionnaire survey have suggested that the greatest barrier against the future development of psychosomatic medicine is the problem of medical care economy. We propose that re-recognition and re-evaluation be made of the role of "general hospital psychratry in shouldering the responsibility of psychosomatic medicine" in the coming 21st century and look forward to substantiating psychosomatic medical care system with other departments of medicine and to strengthening the backup in medical care economy.

View full abstract

The purpose of this study was to investigate the effect of self-efficacy on quality of life and psychologi cal stress responses in heart failure patients. Subjects were 30 (17 males and 13 females) heart failure patients and 30 (17 males and 13 females) matched non-clinical adults. Results of comparison of self-efficacy and psychological stress responses between heart failure patients and non-clinical adults revealed that heart failure patients felt lower self-efficacy and higher helplessness than non-clinical adults. Results of investigation of the relationship among NYHA classification of cardiac functioning, quality of life, and psychological stress responses suggested that quality of life and psychological stress responses were not associated with symptoms of cardiac functioning. Furthermore, the results of investigation of the effect of self-efficacy on quality of life and psychological stress responses revealed that patients whose "Posrtrveness m behavror" score and "Socral locus of ability" score were high and "Anxiety concerning failure" ecore was low felt high quality of life and low psychological stress responses. Finally, the effectiveness of self-efficacy on improving the quality of life and alleviating psychological stress responses in heart failure patient in clinical settings were discussed,

View full abstract